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Prosthesis Salvage in Breast Reconstruction Patients with Periprosthetic Infection and Exposure

Prince, Melanie D. M.D.; Suber, Jessica S. M.D.; Aya-ay, Melanie L. M.D.; Cone, Jeffrey D. Jr. M.D.; Greene, John N. M.D.; Smith, David J. Jr. M.D.; Smith, Paul D. M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182361fbd
Breast: Original Articles
Abstract

Background: Breast prosthesis reconstruction continues to be the most common form of breast reconstruction, and infection and exposure remain major concerns for patients and surgeons.

Methods: A retrospective review was performed of patients who underwent attempted implant salvage between 2002 and 2008 by a single surgeon according to a single protocol. Analyzed data include detailed patient demographics, clinical and laboratory findings, and outcomes.

Results: Sixty patients were identified who had been taken to the operating room secondary to infection and/or exposure of a breast prosthesis. Seventeen underwent removal of the prosthesis without attempted salvage and 43 patients underwent attempted salvage. Successful attempted salvage occurred in 76.7 percent of cases, with a mean follow-up of 18.4 months (range, 1 to 60 months). Staphylococcus epidermidis led to a statistically higher rate of failed salvage (25 percent versus 0 percent, p = 0.04). Of the 33 patients who had successful salvage of the prosthesis, two developed capsular contracture (6 percent).

Conclusions: Intervention should be prompt and aggressive, and should implement a combination of surgical and antimicrobial therapies. The data from the authors' results provide additional tools for patient selection and treatment, and offer a simplified management protocol for breast reconstruction patients with infected and/or exposed breast prostheses.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Author Information

Tampa, Fla.

From the Division of Plastic Surgery, Department of Surgery, and the Division of Infectious Diseases and Internal Medicine, University of South Florida.

Received for publication March 11, 2011; accepted June 14, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Paul D. Smith, M.D.; Division of Plastic Surgery, Department of Surgery, Tampa General Circle, 7th Floor Mailroom, Tampa, Fla. 33606, psmith@netzero.com

©2012American Society of Plastic Surgeons